September 24, 2010

The FDA has for all practical purposes killed Avandia. Patients will have to be given a scary disclosure form to sign if it is prescribed and it can't be prescribed without the doctor filling in paperwork explaining why the patient couldn't be put on Actos.

The flaw here is that Actos is just as dangerous a drug. Here is a brief list of the problems with Actos. You can find the citations to the studies backing up each of these statements on this page: Actos and Avandia: Dangerous Diabetes Drugs.

1. Actos can cause heart failure in young people who did not have any signs of heart failure before taking it. Heart failure is a weakening of the heart muscle that is almost always fatal after a number of years of increasing debility.

2. Actos taken over long periods of time damages the structure of the arm and leg bones in a way that causes fractures. By the time these fractures occur, it is too late to do anything about the damaged bones because how Actos works is that it turns the stem cells that should have turned into bone cells into fat cells which absorb glucose and turn it into body fat. That's a heckuva way to lower blood sugar, but that is what it does.

3. Actos makes people gain weight in the form of new fat cells that they are stuck with forever even if they stop the drug. (See #2 for why.)

4. Actos has been shown in studies to be less effective than the wimpiest high carb dietary changes (mostly calorie restriction) and mild exercise. Actos is far less effective than the adoption of a diet of 100 g a day of carbohydrate or less.

5. Actos causes macular edema--i.e. swelling in the most sensitive part of the retina which causes blindness.

6. Actos appears to raise the risk of bladder cancer. This occurs when the drug is taken for a longer period or at higher doses.

You risk all this in exchange for an average drop in A1c of .2% (at the 15 and 30mg doses) and .9% drop at the 45 mg dose at which bladder cancer becomes an issue. And those drops are in a population whose average A1c was 10% at the start of the study, meaning that after taking this dangerous drug for 6 months they still had A1cs in the 9% range we know will cause blindness, amputation, kidney failure and heart attack death. That finding is reported, somewhat deceptively here:

In contrast to this miserably poor improvement, hundreds of people who cut down on their carbs following the advice you will find HERE report dropping A1cs from 10% or more down to the 5%-6% range at which complications are very, very rare.

I had no idea Actos had a negative effect on your vision. I was on it for a while and had to stop taking it because my insurance changed and the out-of-pocket cost went from $30/month to $190/month (Dr. Parker, you are absolutely correct about the cost). While I was on it, I complained to my doctor that I was having weird problems with my vision, but she didn't take me seriously because I couldn't describe it well. I even asked the eye doctor about it on my annual exam. The problem is gone now, and it occurs to me that it went away around the time I stopped the Actos. I hadn't made the connection before. In a way, I'm very glad my insurance changed and the drug became unaffordable. I feel like I dodged a real bullet.

Unfortunately, because doctors are obsessed with heart attack and ignore most other significant side effects, Actos is still being heavily promoted. It will probably stay on the market, though better educated doctors who bother to keep up with the research NOT funded by the drug maker are prescribing it less.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.